Positive Strategies Men Regularly Use to Prevent and Manage Depression

A National Survey of Australian Men

Judy Proudfoot; Andrea S. Fogarty; Isabel McTigue; Sally Nathan; Erin L. Whittle; Helen Christensen; Michael J. Player; Dusan Hadzi-Pavlovic; Kay Wilhelm

Disclosures

BMC Public Health. 2015;15(1136) 

In This Article

Results

During data collection in April and May 2014, 689 men were eligible and consented to participate. Of those, 465 men completed the survey, giving a response rate of 67 %. Results are presented for these 465 men. There were no significant differences between those who completed the survey and those who did not on age, marital status, education or employment (all p's > .05).

Participants

Participants ranged in age from 18 to 74 years old, with a mean age of 40.6 (SD 12.3) years. A majority (76.1 %; n = 354) were employed full-time, part-time or self-employed. More than half (56.8 %; n = 264) were married or in a de facto partnership and about half (49.0 %; n = 228) held a bachelor degree or higher. The majority lived in metropolitan areas throughout Australia (78.1 %; n = 363).

Participants' mean scores on the MDRS and its six subscales were as follows: total score (M: 40.35, SD: 1.19), distress (M: 15.41, SD: .331), drug use (M: 2.02, SD: .226), alcohol use (M: 6.55, SD: .383), anger and aggression (M: 6.61, SD: .328), somatic symptoms (M: 6.16, SD: .298) and risk-taking (M: 3.62, SD: .205). With the exception of the distress subscale, which was in the mid-range, all sub-scale means were low, which is comparable with other samples of men recruited online.[23] Nearly a third (32.0 %; n = 149) reported no or minimal current depression on the PHQ-9, with the remainder reporting mild (32.3 %; n = 150), moderate (15.5 %, n = 72), moderately severe (10.8 %; n = 50), or severe (9.5 %; n = 44) depression. A large majority (93.5 %; n = 435) had ever experienced depression, with 54.6 % (n = 254) reporting they had received treatment for depression.

Use of Strategies to Prevent and Manage Depression

Table 1 shows participants' use of prevention strategies (i.e., "to keep myself feeling OK or on an even keel from day to day") and Table 2 shows use of management strategies (i.e., "to pick myself up in the times I'm feeling flat or down"). The mean number of prevention strategies used was 16.8 (SD 4.1) and the mean number of management strategies used was 15.1 (SD 5.1).

Prevention Strategies: Regular and Occasional use. The five most regularly used prevention strategies were: eating healthily (54.2 %; n = 252), keeping myself busy (50.1 %; n = 233), exercise (44.9 %; n = 209), using humour to reframe my thoughts/feelings (41.1 %; n = 191), and doing something to help another person 35.7 %; n = 166). The five most common strategies used occasionally to prevent depression were: reward myself with something enjoyable (51.4 %; n = 239), achieve something (big or small) (49.9 %; n = 232), remind myself everyone messes up from time to time (49.5 %; n = 230), do something to help another person (49 %; n = 228) and distract myself from negative thoughts or feelings (48.4 %; n = 225).

In total, 14 of the 26 prevention strategies were used (regularly or occasionally) by 70 % or more of the men.

Additional Prevention Strategies. The men in the study used free-text to report other prevention strategies that they found useful, which were not expressly mentioned in the survey. The majority of these responses fell into three main categories of (i) specific pleasurable activities, (ii) relationships and/or social connections, and (iii) improving physical health. Examples include: reading/listening to podcasts, writing (e.g., letters, journals, blogs, poetry), listening to music and playing musical instruments, travelling, watching television or films ("it allows me to forget for a few hours"), taking photographs, playing computer games, getting outdoors (e.g., "immerse myself in nature" or "sunshine and fresh air"), motor-cycle riding, fishing, having sex, masturbation, cooking, completing puzzles and taking Vitamin B and fish oil tablets. A few mentioned the importance of routines, such as scheduling in "me-time". Others emphasised the importance of having goals and reviewing previous achievements (e.g., "I look at all I have achieved and remind myself that a lot has changed and I am capable").

Management Strategies: Regular and Occasional use. The five most regularly used management strategies were: take some time out (35.7 %; n = 166), reward myself with something enjoyable (35.1 %; n = 163), keeping myself busy (35.1 %; n = 163), exercising (33.3 %; n = 155), and spending time with a pet (32.7 %; n = 152). The five most common strategies used occasionally for management were: achieve something (big or small) (46.7 %; n = 217), doing something to help another person (46.5 %; n = 216), talking to people close to me, or someone I trust, about a problem (45.2 %; n = 210), cry (44.5 %; n = 207), and notice my thoughts and try to change my perspective (43.2 %; n = 201).

In total, eight of the 26 management strategies were used (regularly or occasionally) by 70 % or more of the men surveyed.

Additional Management Strategies. Many of the activities used by the men to prevent low mood were also reported in free text as being used as management strategies (e.g., music, watching TV/films, computer games). Additional specific activities were: power walking (e.g., "exercising hard"), ignoring the problem until it has passed, looking at photos or videos from happier moments, lots of rest and 'quiet time' , avoiding people or cancelling appointments until feeling better, taking time to evaluate what has gone wrong (e.g., "analyse situations, find alternate explanations for others' reaction"), trying not to worry about things, reviewing medication doses, making plans for the future for something to look forward to, "fake it until I make it", and spending time with family and pets. Answers often emphasised being gentle with oneself (e.g., "Don't push myself too hard"), taking the needed time to recuperate, and choosing interactions with others carefully (e.g., "Stay away from people who put me down").

Openness to Using New Strategies

Overall, respondents reported being open to using new strategies. The top five prevention strategies that the most men in the study were open to using (i.e., 'I don't do this, but I think it is a good idea') were maintaining a relationship with a mentor (58.3 %; n = 271), joining a group, club or team (48.0 %; n = 223); meditation, mindfulness or gratitude (46.5 %; n = 216), seeing a health professional (40.9 %; n = 190) and focusing on life's purpose (38.7 %; n = 180). The top five management strategies men did not use, but were open to using were: contacting a mentor when feeling down (57.8 %; n = 269), joining a group club or team (47.3 %; n = 220), meditation, mindfulness or gratitude (45.2 %; n = 210), setting goals for the future (41.7 %; n = 194) and seeing a health professional (41.3 %; n = 192).

Strategies Least Likely to be Used for Prevention or Management

The five prevention strategies that participants did not use and were not open to using (i.e., 'I don't use this, and I wouldn't ever') were: following faith, religion or spirituality (59.4 %; n = 276), crying (24.1 %; n = 112), focusing on life's purpose (18.7 %; n = 87), maintaining a relationship with a mentor (17.2 %; n = 80) and practicing meditation, mindfulness or gratitude (17.0 %; n = 79/465). The five management strategies that the most men did not use and were not open to using were: following faith, religion or spirituality (58.1 %; n = 270), focusing on life's purpose (20.9 %; n = 97), joining a group, club or team (17.4 %; n = 81) and using positive self-talk (17 %; n = 79).

Strategy use and Demographic Factors

Table 3 shows the proportion of respondents who regularly used each of the five strategy groups for either prevention or management, broken down by age, relationship status and education level. For regularly used prevention strategies, there was a significant difference by age group in the regular use of cognitive strategies (χ2 = 11.18, df = 4, p = .025), and a significant difference by relationship status in the regular use of pleasure-based strategies (χ2 = 17.8, df = 2, p < .001). Likewise, a significant difference in regular use of self-care strategies (χ2 = 7.80, df = 2, p = .020) and achievement-based strategies (χ2 = 8.51, df = 2, p = .014), was observed by education level.

For regularly used management strategies, significant differences were observed by age-group in the regular use of self-care strategies (χ2 = 11.40, df = 4, p = .022), and by relationship status in the regular use of pleasurable strategies (χ2 = 6.67, df = 2, p = .036). Similarly, education levels were significantly related to differences in regular use of cognitive strategies (χ2 = 9.33, df = 2, p = .009), and self-care strategies (χ2 = 6.07, df = 2, p = .048).

Regularly Used Prevention Strategies and Risk of Depression

As shown in Table 4, lower MDRS scores were significantly correlated with older age, having a university degree, being in a relationship, experiencing fewer stressful events in the previous year and using self-care, achievement, cognitive or connectedness strategies regularly for prevention.

In multivariate analyses shown in Table 5, lower MDRS scores were significantly and independently associated with older age, experiencing fewer stressful events, and using self-care, achievement and cognitive strategies regularly. Model 1 Prevention was associated with 10 % of the variance shown in MDRS scores. The addition of regularly used prevention strategies in Model 2 Prevention accounted for a significant change in R2 , with the final model accounting for 18 % of the variance in total MDRS scores.

Regularly Used Management Strategies and Depression Symptoms

As shown in Table 6, total PHQ-9 scores were significantly correlated with age, education level, relationship status, employment, number of stressful events and achievement and cognitive management strategies.

In multivariate analyses shown in Table 7, Model 1 Management shows that being unemployed, not tertiary educated, and experiencing more stressful events significantly predicted 18 % of the variance in PHQ-9 scores. After entering regularly used management strategies in the model (Model 2 Management), the total variance explained was 22 % and three factors were found be independently and significantly associated with total PHQ-9 scores. Lower depression symptoms scores were associated with being employed, having a university degree and regularly using cognitive management strategies.

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